Scoliosis treatment is based on the degree of curvature of the spine, viewed from the front or back by X-ray. The following are general guidelines for treatment.
Less Than 10 Degrees
This is not scoliosis. Scoliosis is defined as spinal curvature greater than 10 degrees. Curvature under 10 degrees is considered a normal variation, just as there is a normal range for weight and for height.
10 Degrees to 30 Degrees
In this range, scoliosis is observed to see if it progresses.
30 Degrees to 50 Degrees
In this range, bracing is the standard of care in the United States. The scoliosis brace is known as a TLSO, which stands for thoraco-lumbar spinal orthotic. The idea behind bracing is to stop or slow progression of the curve so that it stays under 50 degrees. The two principal types of braces used are the Milwaukee brace, developed by Dr. Walter Blount of Milwaukee, and the Boston brace, developed by Dr. John Hall of Boston. Brace treatment successfully stops curve progression in about 80 percent of children.
More Than 50 Degrees
Beyond 50 degrees, the spine loses its ability to compensate and progression becomes inevitable even after the child is mature. The only way to stop progression at this stage is a surgery called spinal fusion. Think of the vertebrae as beads on a string. The spine bends between the vertebrae as a string bends between the beads, causing the beads to move. The way to stop the beads from moving is to stick them together. Spinal fusion surgery joins the vertebrae.
There is no clear evidence that untreated scoliosis or scoliosis treated with bracing or spinal fusion will increase the risk of back pain or arthritis in the long term. The younger a child is when diagnosed with scoliosis — or the more the child has to grow — the greater the risk of scoliosis progressing.
After puberty, curves under 50 degrees are not likely to get worse. For this reason, the goal of scoliosis mangement is to keep curves under 50 degrees until the child has matured. Children with curves under 50 degrees typically grow up into adults with no significant problems related to scoliosis.
Medication, Physical Therapy
In most cases, treatment for adults begins with a combination of non-surgical treatments administered from several weeks to months. These include:
Minimally Invasive Surgery
UCSF Medical Center is one of the few medical centers in Northern California to offer advanced minimally invasive spinal fusion surgery. These include XLIF (eXtreme Lasteral Interbody Fusion) or DLIF (Direct Lateral Interbody Fusion) procedures that limit the dose of anesthesia and effectively restore quality of life.
During these procedures, a surgeon creates a small portal in a patient's side, between the ribs and hip, minimizing muscle stripping while allowing access to the spine. The procedures enable surgeons to correct the side-to-side curvature of the spine and restore spinal balance or alignment so the spine is not pitched forward.
Potential Complications
A potential complication of spine surgery is damage to the nerves running along the psoas muscle, one of the body's major muscles responsible for stabilizing the base of the spine and allowing the spine to flex and rotate the hip joint. To limit potential nerve injuries, doctors at UCSF Medical Center use neuromonitoring during spine surgery, which allows surgeons to stimulate and test nerves during surgery.
Our doctors also use 3-dimensional imaging techniques during surgery to see the spine more clearly, increase accuracy when placing spinal instruments and improve patient safety.
Treatment for Children
Most spine curves in children with scoliosis will remain small and need only to be watched by an orthopedist for any sign of progression. If a curve does progress, an orthopedic brace can be used to prevent it from getting worse. Children undergoing treatment with orthopedic braces can continue to participate in a full range of physical and social activities.
If the curve of the spine is severe when first seen, or if treatment with a brace does not control the curve, surgery may be necessary.